title: Is complicated gallstone disease preceded by biliary colic?
abstract: BACKGROUND
  Cholecystectomy in cases of "warning" episodes of biliary colic may prevent biliary pancreatitis. We aimed to determine which proportion of patients with biliary pancreatitis, compared to other complicated and uncomplicated symptomatic gallstone disease, experienced "warning" episodes of colic and why these episodes did not lead to early cholecystectomy.
  
  
  METHODS
  One hundred seventy-five patients with complicated gallstone disease [pancreatitis (n = 53), symptomatic common bile duct (CBD) stones (n = 64), and acute cholecystitis (n = 58)] and 175 patients with symptomatic uncomplicated gallstones were interviewed at admission.
  
  
  RESULTS
  Fifty-seven percent (100 of 175) of patients with complicated disease (95% confidence interval = 50-65%) experienced "warning" episodes of biliary colic (pancreatitis 58%, CBD stones 67%, cholecystitis 45%) vs 96% (164 of 175) in uncomplicated disease. Eighty-seven percent of patients with "warning" episodes and complicated disease experienced patient's and general practitioner's delays. General practitioner's delay was more frequent if pain was located in the epigastric region compared to the right upper quadrant (51% vs 38%, P = 0.03).
  
  
  CONCLUSIONS
  Half of patients with biliary pancreatitis experience "warning" episodes of biliary colic, similar to other gallstone complications. In symptomatic patients, complications are often not prevented because of significant delays in diagnosis and treatment.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. m.besselink@umcutrecht.nl
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
authors.forename: Niels G
authors.initials: NG
authors.lastname: Venneman
authors.forename: Peter M
authors.initials: PM
authors.lastname: Go
authors.forename: Ivo A
authors.initials: IA
authors.lastname: Broeders
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.forename: Hein G
authors.initials: HG
authors.lastname: Gooszen
authors.forename: Karel J
authors.initials: KJ
authors.lastname: van Erpecum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002763:Cholecystectomy; D041881:Cholecystitis, Acute / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D015331:Cohort Studies; D003085:Colic / Q000453:epidemiology*; D003137:Common Bile Duct Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult